Provider Demographics
NPI:1659331411
Name:DESAI, BHARGAVI AMISH (RPT)
Entity Type:Individual
Prefix:MRS
First Name:BHARGAVI
Middle Name:AMISH
Last Name:DESAI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 NORTHFIELD AVE
Mailing Address - Street 2:SUITE# 205
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5338
Mailing Address - Country:US
Mailing Address - Phone:973-325-9285
Mailing Address - Fax:973-325-9295
Practice Address - Street 1:81 NORTHFIELD AVE
Practice Address - Street 2:SUITE# 205
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5338
Practice Address - Country:US
Practice Address - Phone:973-325-9285
Practice Address - Fax:973-325-9295
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA 08470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ079491Medicare ID - Type Unspecified